title: Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections.
abstract: Mercy Hospital Springfield is a tertiary care facility with 32 000 discharges and 15 000 inpatient surgeries in 2011. From June 2009 through January 2011, a stable inpatient elective neurosurgery infection rate of 2.15% was observed. The failure mode and effects analysis (FMEA) methodology to reduce inpatient neurosurgery infections was utilized. Following FMEA implementation, overall elective neurosurgery infection rates were reduced to 1.51% and sustained through May 2012. Compared with baseline, the post-FMEA deep-space and organ infection rate was reduced by 41% (P = .052). Overall hospital inpatient clean surgery infection rates for the same time frame did not decrease to the same extent, suggesting a specific effect of the FMEA. The study team believes that the FMEA interventions resulted in 14 fewer expected infections, $270 270 in savings, a 168-day reduction in expected length of stay, and 22 fewer readmissions. Given the serious morbidity and cost of health care-associated infections, the study team concludes that FMEA implementation was clinically cost-effective.
authors.affiliation: Mercy Medical Research Institute, Springfield, MO Alexander.hover@mercy.net.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Hover
authors.affiliation: Mercy Hospital, Springfield, MO.
authors.forename: William W
authors.initials: WW
authors.lastname: Sistrunk
authors.affiliation: Mercy Hospital, Springfield, MO.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cavagnol
authors.affiliation: Mercy Hospital, Springfield, MO.
authors.forename: Alan
authors.initials: A
authors.lastname: Scarrow
authors.affiliation: Mercy Medical Research Institute, Springfield, MO.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Finley
authors.affiliation: Mercy Hospital, Springfield, MO.
authors.forename: Audrey D
authors.initials: AD
authors.lastname: Kroencke
authors.affiliation: Mercy Hospital, Springfield, MO.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Walker
mesh_terms: D017046:Cost Savings / Q000379:methods; D017048:Health Care Costs; D000067495:Healthcare Failure Mode and Effect Analysis / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration*; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D062606:Tertiary Care Centers / Q000191:economics / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data
keywords: FMEA; cost-effective; failure mode and effects analysis; neurosurgery; surgical site infection